Book reviews

It is an unusual pleasure to review such a nice book. Every species of Encephalartos and Stangeria indigenous to the Republic of South Africa is succinctly described and illustrated with a full-page plate of the Author's superb color photographs of habit, male and female cones, and leaf details. The taxonomy follows that established by Dyer and Verdoorn in their technical and popular accounts. Descriptions are adapted largely from the earlier works, but some new material is added. The text for each species includes a clear morphological description, a statement of range and habitat, and notes on distinguishing features and cultivation. The author has supplemented published information with her own field observations. Each species is accompanied by a distribution map. These maps are somewhat deceptive because although they seem to show accurate distributions the ranges are very exaggerated. For example, E. woodii, known originally from a single clump, is shown occupying about 1,000 km 2. Additional illustrations include helpful drawings of leaflets and seedling leaves as well as lovely habit sketches by Barbara Jeppe. The introduction contains general information on cycad biology, an identification key based on leaves, and practical advice on cultivation of South African species. The informed treatment of cultivation is accompanied by a strong plea for conservation. Some notion of the impact of man on cycad distribution can be gained by noting that the most spectacular population of cycads in South Africa is the forest of E. transvenosus protected for generations by the Rain Queens of the Lovedu. Even before the present mania for cycad culture, cycad populations were depleted for food use by Bushmen. Strict conservation laws in South Africa now protect cycads in their natural habitats while permitting their increased cultivation through seed exchange. I found very few errors. Figures i and 2 on page 31 are reversed. The Carboniferous (from which there are no known cycads, only related pteridosperms) dates from about 300 million rather than 50 or 60 million years ago. Personally, I feel that the most serious deficiencies of this book are those it has inherited from its predecessors. South African botanists, in proud possession of their own floristic kingdom, have not looked beyond their borders for affinities of their plants. Thus the half dozen or so additional species of Encephalartos in Africa are virtually ignored. In addition, they have concentrated on narrow circumscriptions of taxa and have neglected their mutual affinities. In this book, each species is compared with only one or two others. Perhaps these are the only comparisons needed for identifications, but the matter leaves an uneasy feeling. Evolutionary scruples aside, this is the finest popular taxonomic and cultural account of any group of cycads in the English language. JAMES E. ECKENWALDER Fairchild Tropical Garden Miami, Florida

sometimes unknown to* or purposely overlooked-.by'those-about-herT At length the disappearance of a discharge, to.which-the sex are, with much propriety, very attentive, gives the first.-alami;> but before this, considerable mischief has taken place, and the uterus is only one of various organs whose functions are interrupted. ' After this preface, we shall proceed to give the case in the author's own words. " A young woman, aged 20 years, of a very.-delicate habit, butin pretty good health, had experienced about five months ago aur obstruction of the menses in consequence of cold;. from this time her health gradually declined, she became languid-and weak, had* frequent pains in her side, and occasionally a short dry cough.* Her appetite was impaired, and she became rathen emaciated. In the month of July I first saw her; at this time she complained of' pain in the left side* occasional fits of coughing, which recurred; at uncertain intervals, but generally with considerable violence-, right and morning. She had scarcely;any expectoration, littlethirst, pulse 120, appetite impaired, bowels regular, countenance' and lips very pale ; there had been no return of the menses since their first suppression. A blister was immediately applied to thepained part, and directed to be kept open; five, grains:o? rubigoi ferri, combined with myrrh and castor, to be given three times; a-day, with infusion of chamomile flowers, and the feet to be irii*. mersed in warm water every night. The pain was removed by the-i blister, and it was healed up. The medicines were continued about? six weeks ; during this time the pain occasionally recurred, which; was always soon removed by a blister. The cough was sometimes considerably better, sometimes aggravated, with trifling1 expectora-* tion ; her pulse was diminished to t)0 her appetite improved*, and* her countenance looked better. I now discontinued my attendance^ and have since learned, that the only remedies she' afterwards usedwere, expectorants and blisters, occasionally, wheiT>'there wascough or pain, and she entirely omitted n\l other medicines: Sher continued without much alteration, excepting that sheigradually* grew weaker,, and within the last fortnight was almost conSned to"1 bed, without, however, the cough or expectoration 'being greaterthan before. On the Saturday morning previous to her death,-sho was seized with violent excruciating pain in the abdomeny* particularly about the umbilicus, which continued, with more.or less via-* lence, for several hours ; it then left her, and she seemed inuch iref the same state as before, until ? the Thursday morning, October 13th, when, soon after having got. out of and-into bed,, .without1 assistance, she suddenly expired. " On opening the thorax, there was found a very general adhew* tion of the pleura pulmonum to the pleura cos talis, yet-not'So j firmly but they might be easily separated by the fingers ; there wasa small quantity of fluid'in thfj cavity,-not exceeding three or four ouuees ;-the, lungs were very dense,-and ofa dark colour,-re>-* seinbUug; ?40 The Edinbur&h Journal. *> sembling the liver'in appearance ; portions of them, wfien put into water, fell to the bottom* Being cut into, some of the bronchial cells contained a purulent matter, but in small quantity, and here and there was a small excavation the size of a pea; a few small tubercles also were found, not inflamed. The external surface of all the small intestines was very red, and seemed to be studded with, small red points, resembling the villous coat of the same intestines when injected. There was no appearance of gangrene, neither Was'there any adhesion between the different convolutions of them, Bpr between any of them and the peritonamm ; the omentum also was extremely vascular, the mesenteric glands were enlarged and hardened in several places, the pancreas, spleen, and other viscera, were of their natural appearance. " That the lungs were injured in a great degree, was evident frojn the tubercles found in them, and from the pus contained in the bronchial cells, but still, the ulceration had not arisen to such, a height as to be the immediate cause of death. More extensive affections than the present one are perhaps frequently recovered, from, and tubercles may remain for many years with impunity, if no exciting cause of inflammation arise. Although, likewise, therewere marks of inflammation upon the intestines, yet this inflammation did not immediately destroy the patientfor the pain had left her some days-previous to her death, indicating a cessation of the : inflammation, which, as it was not followed by gangrene, cannot ? be considered as the cause of death. The enlarged state of the mesenteric glands affords a presumption, that the flow of chyle into the blood-vessels might have been interrupted, but certainly therewas not sufficient appearance of emaciation in the'dead body, to' enable us to attribute her death to this circumstance. We mlist look, for-the cause of death, not in the affection or destruction of any one particular organ, but in that state of general debility, consequent upon the interruption of a very important function in the female economy, during which state of debility, parts of the body peculiarly predisposed are very apt to take on disease. In the present patient* there appeared to exist a scrofulous diathesis, wherein the lungs.and mesenteric glands are always readily susceptible of disease, from the slightest causes, and always the more readily the greater the state of weakness in the system, however induced. Every kind of weakness is accompanied with irregularity in the action of the living power; hence spasmodic contractions of various parts. This disposition to preternatural contraction is particularly observable to take place in the blood-vessels, in all cases of amenorrhea, forming the principal .symptom in what has been called chlorosis, differing from hectic fever, chiefly, in depending upon a morbid action of the vessels themselves, independent of the absorption jofi extraneous acrimony. This state of the vessels is perhaps ' at first produced by plethora, arising from a retention of a quantity of blood, which excites the larger arteries to stronger action, while ? yet the resistance in. the extreme vessels in the uterus is not overcom?! ?41 come by its increased action, long continued, exhausts the living power, and produces weakness, ?>u"ring this state of general Weakness, and morbid action of the blood-vessels, partial inflammations are very apt to arise. No woiider, then, that the lungs, when, from constitutional, predisposition, they are so susceptible of disease, should be one of the first parti to take 011 inflammation., If by Suitable remedied (he lungs are relieved, (the disposition to general inflammation still continuing fiom its original cause, the suppression not being removed) some other part is very readily affected ; hence in the present case arose the inflamed state of the intestines, during which, all the thoracic symptoms disappeared.
That this irregularity of action in the vessels, sometimes exciting symptoms of inflammation in one part, sometimes in another; entirely depends Upon the suppression of the menses, is evident, from, its generally ceasing upon the return of that evacuation, and from the perfect restoration of health immediately following it. No occurrence is more common than the attack of cough, pain in the side, and difficulty of breathing in females, soon tij'ttr the obstruction ot the menses, and upon their recurrence all these symptoms going off." " Dr. Beddoes, it is urged, observes, ' In some instances, whert the fox-glove has removed the hectic fever, and greatly reduced the expectoration and cottgh, the decline shall become almost imperceptible,-tire patient frequently appearing chlorotic, but being really phthisical, as the event most commonly, and sometimes dissection#, has evinced/ This serves to confirm the opinion, that the pulmonary symptoms are not in these cases the original idiopathic disease.
If it be objected, that this doctrine can only be applicable to incipient phthisis in females, I would appeal to the experience 6f practitioners to determine, whether, in the fern-ale sex generally, the approach of phthisis is not more insidious, and its progress more slow than in men. where w6 usually find the attack more marked, and immediately consequent upon some obvious occasional* cause, the symptoois sooner becoming more violent, and its whole progress more rapid. That this difference' in the appearance of the disease arises chiefly from its frequently being l'ather symptomatic than idiopathic in'females, will be apparent, if we find, that when phthisis arises in them from some obvious occasional cause, and where there has ricver occurred suppression of the menses, its attack and progress are more marked and rapid, than in the male. That it is so, I think experience will justify me in asserting; and impressed with this opinion, I cannot but recommend that we should keep in view the probable dependence of the pulmonary symptoms upon the interrupted functions of the uterus, and direct our treatment accordingly, at least, until we are convinced upon trial, that the opinion itsc-If is fallacious, &nd the pioposed treatment inefficacious or prejudicial." Mr. Abemethy's Surgical Observations: lebrated recipe of Dr. Griffiths, and thfe success with which it is sometimes attended in cases which threaten pulmonary consumption. On the whole, the paper abounds with usetul practical remarks.
Article 11.?Case of a singular Disease of the Heart. By Henry Wisiiart, Member of the Royal College of Surgeons, and one of the Surgeons of the Public Dispensary, at Edinburgh. Another melancholy case, apparently arising from inflammation at the source of the circulation. We trust the frequent occurrence of such cases, will gradually convince every practitioner how improperly the lancet has been omitted, or how absurdly it has been dreaded in many cases of intense pain in those regions which contain viscera, the interrupted functions of which, must produce a calamitous life, if not an early death. We shall not be suspected of arraigning the practice of any individual. The commencement of the above case was much before the relator was consulted.
Ilis candour and accuracy does him equal credit. But we wish to take every opportunity of impressing on that class of our readers, who, for the most part, sec diseases in their earliest stage, the importance of arresting them in the beginning, watching the progress of the patient's convalescence, and even for some years after attending carefully to every symptom, especially at periods of the year which have previously proved alarming.
Surgical Observations on the constitutional Origin and Treatment of Local Diseases; and on Aneurisms. By John Abernetiiy, F. R. S. Honorary Member of the Royal Medical Society of Edinburgh, and of the Medical Societies of Paris, Philadelphia, &c. Assistant Surgeon to St. Bartholomew's Hospital, and Teacher of Anatomy and Surgery.
By a Preface v\e are informed, that this work is to be 'considered a republication of the Author's former writings, leaving out the physiological parts.
We cannot help apprehending something of the same kind i:? our own days. That men of experience may entertain their favourite notions, and even model those notions to the facts before theni, we can easily conceive ; and if their practice varies conformably, no injury will be suffered. But if doctrines, apparently simple, and applicable to all cases, are strongly impressed on young men, will there not be too much reason to fear lest the result should be an uniformity in practice, scarcely consistent with the variety of forms in which diseases present themselves in different subjects and at different seasons ? We wish these suggestions to be considered in a very general view, and shall now proceed to our Remarks on the Work, which is introduced in. the following manner.
*' An evil, (says our Author) seems to me to have arisen from the artificial division of the healing art into the medical a-nd surgical departments. This division has caused the attention of the physician and the surgeon to be too. exclusively directed to those diseases, which custom has arbitrarily allotted to their care. The effects of local disorders upon the constitution have in consequence been too little attended to ; and indeed I know of no book, to which I can refer a surgical student for a satisfactory account of those-febrile ami nervous affections which local disease produces, elcept that of Mr. Hunter. The reciprocal operation of constitutional disorders upon local diseases has obtained still less attention. To investigate more particularly some parts of these subjects, and to submit them to public notice, are the proposed objects of the present paper. ' No part of the animal body can in general be very considerably disordered, without occasioning a correspondent derangement in other parts of the system. Such disorder has been considered by Mr. Hunter as the result of universal sympathy. This consent of the whole constitution with its parts, manifests itself, in particular instance], by a greater disturbance of the functions of some organs than of those of others; and from this circumstance diseases have derived the appellations by which they are commonly distinguished. If the actions of the sanguiferous system be principally disturbed, and the temperature of the body subject to unusual variations,, the disease is termed fever ; if the nervous system be chiefly affectbd, a state of vigilance or of delirium may be produced; convulsions and tetanus take place when the functions of (he muscular system are more particularly deranged. Though the disorder of particular organs thus give a character.and denomination to the disease, it is sufficiently evident, in the instances addu* ted, that the whole constitution is disturbed ; while certain parts, are chiefly affected, perhaps from unknown circumstances relative to thf nervous system, or from a predisposition to disorder existing in the affccted parts. It seems to be ascertained, that persons of particular constitutions are predisposed to-those febrile action* of the 'sanguiferous system, which constitute, the inflammatory, fever ; Mr. Alernethy's Surgical Observations. <245 ver ; that .there is a propensity to convulsions in children; and to tetanus in the inhabitants .of warm climates. " It may be a fit subject for inquiry, whether it,be possible for particular organs to become affected otherwise than through .the 1 nervous system in general. Though some instances of sympathy are strange, and perhaps inexplicable, there are strong reasons for believing that the inflammatory fever, the state of vigilancfe and delirium, convulsions and tetanus, which arise in consequence o| injuries of the limbs, are produced by irritation imparted to the brain, which, by a kind of reflected operation, occasions a greater disorder of some of the organs of the body than of others, and thus gives a character and denomination to the disease. " That the stomach and boweis are disordered by injtries and diseases of parts of the body, ha* been remarked by various, persons.; but the subject has never been extensively surveyed., nor viewed with thai accuracy of observation, which its high importance merits^ It has been observed, that sprains of tendinous or Ligamentous parts produce sudden sickness ; and Mr. Hunter has attributed that shivering which is consequent to accidents, .and atrr tendant on some diseases, to the state of the stomach. It is known that, in some local injuries from'accident or operations, the stomach has appeared to be the part principally affected. But remarks on the affections thus induced in the digestive organs have, been made pnly in a cursoYy ipanner; and it is my intention to examine the subject more particularly. It also appears to me,, that the connection of local diseases with the state of the constitution in general, is either not sufficiently understood, or not duly regarded, by the generality of practitioners; and 1 also mean to claim their particular attention to this subject. I shall in the first place select a case, to shew how the stomach and bo\vels, or, to speak yet more extensively, the digestive organs n?ay be affected frorn local disorder." It is impossible not to regret the vast scope of reflection th^t js forced op the reader in this short passage, without time to look about himj or any clue to direct him-I\Ir. Hunter is first introduced by referring the student .to the largest, most profound, and in so.ijie respects, most complicated of all his works, and without the slightest direction to any passage; yet this is the oply book iu which will be found a " satisfactory account o,f those febrile and Hervous affections which local disease produces." We are afterwards indeed informed, that Mr. Hunter considers such disorders as " the result of universal sympathy ;" and iji a l?fotp we are further t?ld, that it is the remote sympathy of the " patient and industrious' Mr. Hunter of which Mr,. Abcrnethy spea,ks. By all this, we suppose it must be the intention of the Author to distinguish between that sympathy which shows itself by the ajtlectiop qf only one organ, from that which aft'ccts the whole constitution.
Mr. Hunter has indeed explained himself with sufficient accuracy iu this distinction. With him, the sympathy of the whole consti-? 3 tution 24(5 Mr, Abcrneihy's Surgical Observations. tution is well enough known by the terms symptomatic and hectic fever, and the remote partial is not less understood by the affection of the head with the stomach, the stomach with the uterus, ten-* dons, and many other parts. All this, though intelligible in Mr. Hunter, it must be confessed, is related with more brevity than its importance, as a fundamental doctrine, seems to admit. Whether it is more perspicuous in Mr. Abernethy, our Readers must determine.
A case follows, in which the operation for the omental hernia tvas followed by symptomatic fever of three days. In the beginning, the stomach rejected every thing that was swallowed. After copious bleeding the sickness abated ; but the tongue was furred, the skin hot, and the pulse quick, with great watchfulness. The patient took small doses of Epsom salts, and other purgatives, which remained on his stomach, but produced no effect. On the fourth morning, be '' felt his bowels, to use his own expression, apparently filling; and a profuse discharge ensued. A dozen copious, fetid, and black evacuations took place between five and ten o'clock, and he had several others in the course of the day ; after which his appetite returned, his tongue became clean, and a sound and continued sleep succeeded." Mr. Abernethy remarks, that on this occasion the chylopoietic Organs were the parts chiefly affected. We are by no means' disposed to question this, for there cannot be a doubt that in all fevers, from whatever cause, all the functions are disordered ; and the great importance of those abovementioned, render them the earliest object of attention. In such a state as this, it is not to "be wondered if the intestines were insensible to very powerful stimuli, nor that their sensibility returned as the system at large recovered from its symptomatic irritation. " It is probable also, (says Mr. A.) that the restlessness and anxiety of the patient were aggravated, if not principally caused,' by the state of the chylopoietic viscera ; since the relief which took place in those parts on the renewal of secretions into them,' certainly removed the nervous and febrile symptoms. That the discharges were the effect of secretion is proved by the absence of alimentary matter in the bowels, in consequence of the action of the purgative administered on the morning of the operation, and the abstinence both before and after that period." For our own parts, we should be disposed to consider the disorder in the chylopoietic organs as [part of that general irritation which induced disorder in every other part; and we should, for the same reason, consider the improved condition of those organs, and their sensibility to stimuli, as the consequence of the Cessation of that general irritation, that symptomatic fever, that universal sympathy, which was excited by the operation. It is scarcely less common for the brain to be affected under similar cir-? Stances than the stomach and bowels; in short, universal sympathy is excited, and those parts suffer most which, according to the conMitu-Mr. Abcrnethy's Surgical Observations. 247} constitutional peculiarity of the patient, are most easily irritate-!.-Whilst this irritation continues, every attempt at producing the customary effects of medicine will prove abortive. If symptoms of inflammation attend, bleeding is the only remedy ; after which,. quiet, and the administration of such simple liquids as are found, most agreeable to the patient, are all that can be attempted till the irritation subsides. " I could relate (says Mr. Abernethy) numerous cases in support of the inferences which I have drawn from the preceding history, that local irritation acting on the nervous system may affect the digestive organs in a very serious manner, andthereby Creategreat general disorder of the system, which is afterwards alleviated in proportion, to the amendment that ensues in the state of those viscera.
Such consequences of great local irritation must frequently, occur to everyone; it is therefore unnecessary to adduce move instances to support the opinions here delivered.
" With respect to the treatment of cases of this description it may be light to add, that the primary object should be to produce secretion from the irritable organs. In the case which has been re-, lated, and in many others recorded in this volume, the effect of secretions occurring from the disordered organs in relieving their irritable state is very manifest.
In many instances opium will not prevent continual efforts to vomit, yet when by magnes. vitriolati or purgatives administered in the form of pills and clysters, stools are procured, the vomiting ceases, the stomach retains both food and medicine, and general tranquillity of constitution is as suddenly restored" We should rather say, that when these organs recover with the rest from the universal sympathy, their secretions will follow the customary stimuli. In the above case, Mr. A's primary object was copious bleeding, before which the stomach rejected every thing. ; A Chapter, or a proposition follows, entitled, " A slighter degree of continued local irritation will produce a less violent disorder of the digestive organs." In this we meet with nothing to which we can object, excepting that some well known practical facts are delivered in a language which would lead us to suppose that the author was telling us something new. We extract the following paragraphs, to show the author's mode of describing hcctic fever from 'large abscesses ; the mode in which a common ulcer partakes of the fluctuations of health in an irritable subject; and the various sympathies attending dentition. " If then, (says Mr. A.) vehement local irritation can produce a violent disturbance of the chvlopoietic organs, it may be expected that a less degree of a similar cause will produce slighter effects of the same nature.
Indeed, tlie foregoing case was related not merely because.it seemed worthy of record by itself, but chiefly to prepare the reader for the observations which are to follow. all kinds of local disease, which impart considerable and continued irritation to the whole constitution. We also find a less important disease, as, for instance, a fretful ulcer, keep up a disorder of the system in general, and of the digestive organs in particular, which subsides as the irritable state of the ulcer diminishes. But as practitioners in general'may not, perhaps, have so attentively remarked these circumstances, as to be familiarly acquainted with them, it may be useful to mention a very common occurrence, which canho.t have escaped observation. I allude to the effects of the irritation of teething upon the health of children. The brain is sometimes so affected as to cause convulsions; the digestive organs fire almost constantly disordered. The appetite fails ; the tongue is furred ; the secretions of the liver are either suspended, diminished, or vitiated. The bowels are either purgeJ or costivc, and the fasces fetid. The faecal matter is often mixed with mucous and other secretions. There is also frequently a very troublesome tough. Such symptoms generally subside when the local irritation ceases, but sometimes the disorder of the digestive organs, thus excited, continues and disturbs the general health of the patient." ' Th& subject of the digestive organs, of the biliary secretions, and of the alvine discharges, is continued for several pages 5 but whatever axioms or inferences the author may wish to draw, we confess reluctantly, that we have not been able satisfactorily to inform ourselves. There arc many common remarks mixed with others which are more new; but the loose manner in which the \yhole is tacked together, deprives the reader of many advantages, which the experience of Mr. Abernethy must otherwise have afforded. In the mid?t of many conjectures on the use of the bile, we have the following passage in the foim of a Note. " In the inquiry into the probable uses of the bile, it ought to be observed; that in many persons, in whom that secretion is"either lor a considerable time wholly suppressed, very deficient, or much depraved, it does nof appear that the nutrition of the body is defee live.'?
In a work intended to instruct the younger practitioners, it would liave beeh desirable, that this note should have been taken into the text and more extended.
By the last limb of the sentence, is it intended wfe should understand, that the body being nourished as before, 110 inconvenience occurs to digestion from the loss of bile ? or is it only meant to show, that the quantity of fat may be the same, though digestion is injured from a deficiency of bile ? It is certain,' that in children'who live much on milk and farinacea, the stools are frequently colourless without any'appareht want of health, or even of cheerfulness. On this account, we should have thought less of the remarks contained in the note; had not our author insisted, afterwards, so much on the colour of the feces, as indicative of the state of health.
'Another section devoted to this pari of the subject, describes the dcfcct of these orgails as manifested by a dry tongue, furred particu- ?49 Jarly at the back part, pain in the epigastric region, Jujrbid Urinp, &c.; in which we have still to regret the want ot connection or arrangement, whilst we cannot but be pleased with many of the remarks. We are next presented with some paragraphs, superscribed, " Occasional effects of disorder of the digestive organs." This relates principally to the treatment; the plan of which, may be easily conceived, as we have hitherto heard of little but diseases of the digestive organs. Mild aperients with stomachic bitters, and occasionally mercury in small doses. " When the state of the health required it, says Mr. A. or the disease did not yield to the treatment which 1 have described, J have referred the case to the physician ; under whose direction bc.r pefit has been obtained by medicines of more activity than those jvhich I had ventured to recommend, conjoined with tonics, and thosp medicines which are usually termed nervous.
Thus a process which takes placc only during sleep, arises from a weakness in the sphincter vesicas in subjects who, whilst awake, can retain their urine without difficulty. We shall only hint at another very eminent surgeon, who seems rather disposed to cure all diseases, slow fevers among the rest, by setting the urinary organs to rights, just as Mr. Abernethy would cure a defect in the urinary organs by improving the digestion, and thus relieving his patient of a low fever. " I think, says Mr. "Abernethy. that local irritation may dis-'"; ' order Mr. Aberrfethy's Surgical Observations'. <251 order the digestive organs; which disorder continuing, and aggra-* vating the affcction of the sensorium, may possibly lead to the pro.duction of tetanus, at a time when the wound is no longer irritable.
In four cases of tetanus, in which I had an opportunity of inquiring into the state of the bowels, the evacuati. ns from them were not like feces.
I wish to propose, in investigating the cause of tetanus, as a question, What is the state of the bowels between the infliction of the injury and the occurrence of that dreadful malady?* On this passage we shall only remark, that the reader cannot he directed wrong in his practice. The local disease he will of course attend to, nor do we suppose he will be inattentive to any error in the digestive organs. The question proposed at the close of the paragraph is we apprehend intended fur other-climates, where lockjaw is more common. In this country it is so little expected, ai d when it occurs, is so generally after the appearance of a wound is mending, that we shall scarcely persuade every patient to watchthe colour of his forces during the whole period. In warmer cli-i mates the event is more common and more rapid. If in these ai> alteration should be found in the appearance of the fajces, will it not be rather suspected, that the digestive functions have suffered in common with the other parts of the system, than that they have been the immediate cause of lock-jaw ? s In the next Section, the same inquiries and suggestions are continued " on the effect of disorders of digestive organs attending inju-k ries of the head." The 3d section is on " undefined and undenomU nated diseases arising from disorder of the constitution tl;c 4th, "?on more defined diseases, as carbuncle and scrofula, arising from' disorders of the consiitutionthe 5th, " on diseases of various, glands, arising from disorders of the constitution;" the 6th,, " on disorders of parts which have a continuity of surface with the alimentary canal." As all these are directed to the same object, our readers will not expect us to be very particular in detailing the vanrious cases by which they are illustrated, it is enough to say, that * u Such cases as I have related, with others that it would he foreign-, to my present purpose to mention, have impressed the opinion on my mind, that disorders of the digestive organs may originally cause, or may. secondarily aggravate a nervous disorder; and produce, as has be.en * mentioned, in the nervous system, a diminution of the functions of the brain, or a state of excitation causing delirium, partial nervous inactivity, and insensibility; or the opposite state of irritation and pain; in the muscular system, weakness, tremors, and palsy ; or the contrary affections ot spasms and convulsions.' Could these circumstances he proved, it weuld be scarcely necessary to add, that those painful affections ot parts;, to which perhaps some predisposition exists, may he excited in a similar manner; such as gout and rheumatism. Indeed, rheumatic pains are very usually concomitant upon that state of constitution, which existed in the patients whose cases I am relating." \ there 252 Mr. Abernelhy's Surgical Observations.
there are few disorders, or few parts disordered, that Mr. A. has not relieved by small doses of mercury, stomachic remedies, and gentle purgatives." Nor do we see any necessity for this division of the seat of a disease any more than of the disease itself.
The last mentioned Section, on disorders of parts which have a continuity of surface with the alimentary canal, begins with diseases of the oesophagus, the Eustachian tube, or trumpet, as it is here cabled, and the nose ; after which we have accounts of diseases in the eye, and on the common skin.
It may be urged, that as the skin covers all these parts, the continuity of surface is known to exist. But is not such equally the case with every other part of the body ? Why therefore any distinction on the score of continuity ? in this respect we are ready to make large allowances for Mr. Abernethv's various engagements, and for that inattention to trifles which is sometimes thought characteristic of genius. lJut we cannot so easily excuse his printer.' The following is the order of the Sections as they stand in the book, S. i. II. nf. v. iv. v. v. This has sometimes increased the difficulty of making a clear analysis of the work, and will, we trust, be admitted among our excuses.
The last Section is the most interesting, as it contains what information the author has 44 obtained by dissection, relative to the causation of other diseases by those of the digestive organs." This abounds with many useful passages, some of which we would willingly extract, had we not already exceeded our limit, and did not' anew subject still remain for our notice. I I The operator should divide the immediate coverings of the artery, till he has fairly exposed its surface. When he can touch the bare vessel, he will not, I believe, find any difficulty in separating from it, by means of his finger and thumb, or the blunt edge of an aneurismal needle, the cellular substance that connects it to the contiguous parts. This part of the operation is not painful, and should be performed slowly. The firm sides of the vessel enables the sur?eon clearly to distinguish its surface, and by keeping the finger fn exact contact with it, a passage may be made completely round the artery. Care should be taken not to elevate the. artery more than can be possibly avoided, because the artery would be stretched in its longitudinal direction by so doing; and care should also be taken not to injure the contiguous veins or ilerve9. When the operator has thus gently insinuated his finger between the vessel and its surrounding connexions, so that an inch of its surface is every where exposed, two ligatures may be put tinder it one of which is to be carried upwards, and the other downwards, as' far as the artery is detached, and then tied as firmly as possible. The artery should then be divided by a probe-jointed bistoury in the interspace between the two ligatuies, but nearer to the lower ligature than t^o the upper one. " In my opinion, large arteries should always be tied with moderately thick ligatures, because we may then draw the noose as tightly as possible; without apprehension of cutting or tearing the coats of the vessel,-or of breaking the ligature. Tlie latter occurrence would in many cases prove a very embarrassing circumstance, and rt might be very injurious on account of the jeik communicated to the artery to a considerable distance. Also, whenati artery is tied with a thick ligature, the compression made by it is not so great as to produce s speedy rnortificatron and separation of the end of the vessel, so that the ligature remains, in general, a fortnight before it is detached, and therefore, time is allowed for the consolidation of the sides-of the vessel prior to its separation. " Doctor J-ones, w^hose numerous and accurate experiments hava thrown much light upon the natural means by which haemorrhages are suppressed, thinks that the ligatures should be rou-nd and firm ^ becausc such Cords are most likely to cut the internal coals of the artery. I am solicitous that they should be strong'and'moderately lurge; because, as far as I-haves remarked,, large ligatures remain, longest on the arteries before they are detached*; and in examining, the slumps of patients who have died after amputation, I have frequently seen the sides of the artery unclosed, even thoughthe ligatures have fallen oft' from them," In this extract, we find Mr. Abernethy expressing a wish., that the atteries should preserve all their natural surrounding connections. The advantage of this was long ago suggested in our Journal. Dr. Jones's experiments have since shown, that the preservation of this surrounding connection is of less importance, than the rtguns and mode of applying the ligatures. Mr. Abcrnethey in-, ?
dt'?4 25A Mr* Alertieifty's Surgical Observations, I " deed says, that the ligatures should be moderately thick that we rrfay have no apprehension among other events of " tearing the coats of the vessel." Yet " Dr. Jones, whose "numerous and accurate experiments have thrown so much light on the subject, thinks they should be round and firm, because such are most likely to cut the internal coats of the artery." Now, we very much wish Dr. Jones had been more attended to in this disquisition. That equally indefatigable and ingenious gentleman found, that if the internal coats of the artery are divided, the consequence is a piocess of nature for the obliteration of the vessel, though it should remain undivided, and even retain its permeability. This most important discovery of Dr. Jones, we cannot but regret to see entirely overlooked. It is further to be remarked, that the samegentleman proved experimentally, that if an artery is divided obliquely and transversely less than one fourth of its diameter, then the injury may be^restored ; but ifvmore than one fourth of the diameter, was divided, it was found that ulceration, took place, in order to make a complete division, the object of which appears to be, that the artery may have the advantage of retracting, and also that the process may be set up which is found to follow a complete division of the internal coats, namely, the adhesive inflammation, by which the cavity is obliterated. All these considerations from an author such as Dr. Jones is here described, are, we think, worthy of much more attention than is paid them. Is it not possible that the very mode of tying the arteries, by making ah imperfect division of their internal coats, may have produced ulceration, when a complete division might have induced adhesion and obliteration of their cavities I In the only successful case, we are informed, that Mr. Abernethy passed two " moderately thick ligatures, tying them as firmly as he could." It is much to be wished, that mention had been made, whether the ligatures were round or flat.

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In all other repects -we are pleased with Mr. Abernethy's courage in undertaking, and judgment in conducting such important operations; but in future descriptions of dissections, after such events, we hope more attention will be paid to the result of those invaluable experiments, for which we are so much indebted to Dr. Jones.* * For an account of Dr. Jones's labours, and our remarks on them, see our Journal, vols. xv. and xvi. And for die advantage of preserving tlve surrounding vessels by which an artery is supported, see our Journal, vol, n. 516, ?note, and the passage in the text to which it refers. Udiometrical\